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Sequencing several precursor lesions and the cancer from the same pancreas showed that what look like separate high-grade lesions are often one neoplasm that has crawled along the duct system over years.
Somatic variants of pancreatic cancers and precursor lesions sampled from distinct regions of the same pancreas were analysed. Evolutionary inference showed an ancestral cell initiating and clonally expanding to form one or more lesions, with subsequent driver mutations eventually leading to invasive cancer, a multi-step progression generally spanning many years. Independent high-grade precursor lesions observed in a single pancreas often represent a single neoplasm that has colonised the ductal system, accumulating spatial and genetic divergence.
It reframes multifocal high-grade dysplasia found at surveillance: the pancreas may hold one spreading lesion rather than several, which bears on how much gland to remove.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), Clonal evolution & minimal residual disease, Nature, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center.
Shares Clonal evolution & minimal residual disease, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Whole-exome & whole-genome sequencing, Memorial Sloan Kettering Cancer Center.
Shares Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Memorial Sloan Kettering Cancer Center, Pancreatic ductal adenocarcinoma.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), Clonal evolution & minimal residual disease, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center.
Shares Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Pancreatic ductal adenocarcinoma.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Whole-exome & whole-genome sequencing, Pancreatic ductal adenocarcinoma.
Shares Clonal evolution & minimal residual disease, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Pancreatic ductal adenocarcinoma.
Shares Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatic ductal adenocarcinoma.